Coronary heart disease: pravastatin decreased death and MI.

Clinical bottom line (level 1b)

  1. Revascularised patients with an average cholesterol concentration who were given pravastatin, were less likely to have a coronary heart disease death or a nonfatal MI than those given placebo (NNT = 24 at 5 years) .
  2. Revascularised patients who were given pravastatin were less likely to have a stroke than those given placebo (NNT = 65 at 5 years) .
Flaker et al: Journal of the American College of Cardiology 1999; 34 (1): 106-112
Expires March 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: 80 centres, North America

2245 patients (aged mean 58y, 86% male) survived a myocardial infarction (3 to 20 months before randomisation), had a plasma total cholesterol <240 mg/dL and low density lipoprotein of 115 to 174 mg/dL, who underwent coronary revascularisation before randomisation
Note:
  • Patients are a sub-group of the CARE trial - reported elsewhere
  • Patients had either percutaneous transluminal coronary angioplasty or coronary artery bypass surgery.


    • Control Group: (n = 1118, 1118 analysed): placebo
    Experimental Group: (n = 1127, 1127 analysed): pravastatin 40 mg per day

    100% followed for 5 years

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    coronary heart disease death or nonfatal MI 5 years 139
    (12.4%)    		 93
    (8.25%)    		 34.0%
    (15.0% to 48.0%)    		 4.18%
    (1.67% to 6.70%)    		 24
    (15 to 60)
    stroke 5 years 46
    (4.11%)    		 29
    (2.57%)    		 37.0%
    (1.00% to 60.0%)    		 1.54%
    (0.05% to 3.03%)    		 65
    (33 to 1831)

    Comments

    1. Confirms the findings of the main CARE trial in the two-thirds of patients who had undergone previous revascularisation procedure.
    2. It is interesting to reflect that for some patients, a 'normal' cholesterol is too much.

    Citation

    1. Flaker GC, Warnica JW, Sacks FM, et al: Pravastatin prevents clinical events in revascularized patients with average cholesterol concentrations. Journal of the American College of Cardiology 1999; 34 (1): 106-112
    Contributor: Clare Wotton and Bob Phillips, January 2000
    Reviewer: Dwight Peretz

    Clinical Question.
    Patient revascularised patients
    Intervention or Exposure pravastatin
    Comparison placebo
    Outcome clinical cardiovascular events